Transoral Ultrasound in the Diagnostic Workup of Peritonsillar Abscess—A Randomized Clinical Trial

ABSTRACT Background Peritonsillar abscess (PTA) is a common deep head and neck infection in younger adults. Because the condition can be difficult to distinguish from peritonsillar cellulitis on clinical examination, many patients undergo unnecessary diagnostic blind needle aspiration attempts. For this reason, transoral ultrasound has been suggested as a point‐of‐care imaging modality that may improve the diagnostic workup of PTA. This randomized clinical trial explores whether transoral ultrasound improves the management of patients with peritonsillar infection. Methods A multicenter randomized clinical trial was conducted at the departments of Otorhinolaryngology, Head and Neck Surgery at Copenhagen University Hospital—Rigshospitalet and Odense University Hospital in Denmark. Patients suspected of having a peritonsillar abscess were randomized to either standard clinical examination (control group) or standard clinical examination combined with transoral ultrasound (intervention group). Results Ninety‐five patients (58 at Rigshospitalet and 37 at Odense University Hospital) were included in the study by 28 different physicians. Forty‐seven patients were allocated to the intervention group and 48 to the control group. The diagnostic accuracy was 80.9% in the intervention group versus 72.9% in the control group ( p = 0.50). In the control group, 18 (37.5%) underwent unsuccessful needle aspirations compared to 12 (26.0%) in the intervention group. The intervention group underwent 31.9% fewer needle aspiration attempts compared with the control group ( p < 0.01). Conclusion Transoral ultrasound can significantly decrease the number of needle aspiration attempts in patients with a suspected peritonsillar abscess. Still, we could not find any significant improvement in diagnostic accuracy or improved patient outcomes. Level of Evidence 2.